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Duty of Candour

Health care professionals are required to be open and honest with their patients. When something goes wrong or is unanticipated with a patient’s care or treatment and if it causes or has the potential to cause harm or distress then there exists a professional duty of candour. This is the legal duty to inform, apologise and support patients if such events occur.

inform the patient (or if appropriate their family or advocate) that something has gone wrong or that something unanticipated has occurred

apologise

offer appropriate support and remedy

explain the short and long term consequences of what has happened.

In England there is also now a statutory duty of candour which describes a series of steps (including that of apologising both in person and in writing) that you are legally obliged to follow in the event of a notifiable safety incident. The definition of a notifiable safety incident and the steps you must follow are detailed in the CQC guide below which also includes a series of illustrative examples. It is highly likely that statutory duties of candour will soon be introduced in Scotland, Wales and Northern Ireland as well. It is clear in law that an apology is NOT an admission of negligence; for more detail, see the NHS Litigation Authority guide below. Health professionals should avoid speculating beyond what is currently known, but be open and facilitate the investigation of any untoward event.

Apologies and information sharing must be done in a timely manner, give a step by step and jargon free explanation about what went wrong, must respect confidentiality, and provide ongoing support, ensuring continuity of care.

Where deficits in care are identified it is vital that they are reported to ensure patient safety and to improve the system to avoid recurrence and further harm.

Candour, learning and accountability
In response to several high profile investigations into deaths while under medical care, the CQC conducted an extensive investigation into the reporting and investigation of harm and failings in the NHS.

Deaths are investigated as part of the duty of candour, to support sharing information with families, to improve learning and to demonstrate accountability. Throughout the process the CQC found that families and carers have told them that they often had poor experiences of investigations and were not always treated with kindness, respect and honesty. The report found that there is currently no single framework for NHS trusts that sets out what they need to do to maximise the learning from deaths that may be the result of problems in care. As a result, the CQC made several recommendations which they felt would improve candour and accountability, the experience of patients and relatives and promote learning and improvement in services. Though the report focuses on NHS England and mental health services in particular, many of its lessons are applicable through secondary care and the UK as a whole. The report and recommendations can be found here.